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The following is a guest blog post by Lori Balstad, Learning and Development Specialist at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
While electronic health records (EHRs) have been in existence since the late 1960s, it wasn’t until almost 30 years later that the Institute of Medicine (IOM) concluded that healthcare would be safer with computerized physician order entry, estimating that 100,000 Americans die each year from preventable adverse events. Now in 2015, most have heard the frightening number of deaths per year due to medical errors—400,000—or more than 1,000 lost lives in the U.S. every day. Preventable medical errors cause the third most deaths in the U.S., right after heart disease and cancer. With many organizations either upgrading old systems or making the decision on their first EHR, it is critical that patient safety is the ultimate goal.

The Breakaway Group, A Xerox Company, is committed to ensuring healthcare organizations gain value from technology. Our innovative approach using “flight simulators” allows users to practice new workflows and reinforce the handoffs required to achieve the quality and safety outcomes they expect. Our research-based solution expedites end-user adoption of new technologies and using the EHR system to its full potential. This results in fewer errors, and a higher level of care. Healthcare professionals adopt new applications faster, giving back critical time for providers to do what they do best – care for patients.

Sociotechnologix works to help healthcare organizations understand the influence of culture and leadership on safety and quality of care. The implementation of technology can create significant patient risk when not used correctly or when system issues are ignored post go-live. Sociotechnologix uses a validated assessment to measure HIT safety. This focus on organizational culture drives organizations to integrate quality initiatives into every aspect of care. They recently launched a tool that allows providers to quickly and easily identify patient safety risks in their EHR. The application called SafeHIT, provides detailed analytics on the safety, usability, and workflow, from the perspective of clinicians to prioritize safety issues. As sighted by Westat in a report for The Office of the National Coordinator for Health IT (ONC), “Examining health IT incidents within the context of the socio-technical model enables organizations to look beyond the incident to understand it in the context of the people who use the system and the other technologies and processes affected by health IT. Understanding these interactions enables high-reliability organizations to make improvements to their health IT systems when flaws in the systems are identified that can lead to patient harm.”

In the following Q&A, we discuss how EHRs impact patient safety and how each company hopes to improve it. The individuals interviewed from each company are Dr. Heather Haugen, CEO and Managing Director of The Breakaway Group, and Dr. Michael Woods, a Principal of Sociotechnologix, LLC.

Question #1: How must healthcare change to ensure proper use of EHRs for improved safety?

Heather: We must move beyond an implementation mindset. The hard work begins when the technology is installed. An EHR is simply one tool we can use to improve care processes. It requires clinical leadership and a long term commitment to achieve the promise of the EHR- improved quality and safety.

Michael: No one would give their child a medication the FDA had not approved as safe and effective, yet we don’t think twice about having our child cared for in a hospital that has implemented an EHR whose safety and efficacy for patients (and users) hasn’t been systematically demonstrated. Clinical leaders and their organizations will not be able to optimize quality and patient safety without committing to a structured methodology to capture, track, and fix the EHR safety, usability, and workflow issues encountered daily on the frontline of care.

Question #2: Can you share examples of how your company helps improve patient safety?

Heather: We are witnessing a unique time in healthcare. Healthcare leaders face an increasing number of competing priorities with fewer resources every year. If we continue to quickly push more technology into clinical care processes without ensuring users are proficient, we will experience an increase in errors and negative impact on quality and safety. By mimicking the clinical environment, we can easily assess end user proficiency in their actual workflow before they use the live system. These clinicians are less likely to make an error and learn the system faster. Giving clinicians time back to focus on the patient and properly use the tools results in safer care.

Michael: We use a sociotechnical approach to assess an organization’s overall patient safety. HIT is one of three components in our model, but it has profound impact on the other two, culture and process. In consulting to a number of organizations, we consistently found EHRs leave frontline caregivers frustrated, cognitively burdened (culture), and forcing workarounds (processes) to the EHR to ensure their patients aren’t harmed. We’ve never heard a frontline caregiver say, “Gosh, our HIT system is just so awesome — it’s so intuitive, easy to use, and safe for our patients.” On the other side of the fence, our data tells us our information technology (IT) colleagues are paralyzed by the sheer volume of (legitimate) frontline complaints (“tickets”), often with no way to categorize, prioritize, and track what issues are creating real safety risks, or which HIT usability issue is costing 10’s or even 100’s of thousands of dollars per year in lost efficiency. It’s for these reasons we created SafeHIT™, a mobile, SaaS-based application for real-time, frontline reporting and advanced analytics of HIT safety, usability, & workflow issues. SafeHIT brings the clinical and IT folks together collaboratively to solve HIT problems, leveraging in-App, bi-directional, highly secure communication.

Question #3: How can companies like The Breakaway Group and Sociotechnologix work together to improve patient safety?

Heather: Both organizations are passionate about improving patient safety through research-based solutions. We understand patient safety is a complex issue that must be addressed from multiple touch points in the organization. By pairing our solutions, an organization can address safety across the care continuum – from the leadership culture of safety to how providers use technology to deliver the highest quality of care.

Michael: Heather is spot-on. Sociotechnologix talks about EHR ROS – return on safety – an EHR system that actually helps the entire sociotechnical environment (culture, processes, and technology) be safer. Combining the methodologies and data streams from The Breakaway Group and Sociotechnologix creates a truly unique — and frankly, for the first time — complete approach to not just the initial EHR implementation, but ongoing and sustained EHR proficiency, safety, usability, and workflow optimization, while stopping the pandemic, ongoing lost efficiency costs associated with sub-optimal adoption and usability.

Many government organizations and institutions have also recognized the need to evaluate health IT’s role in patient safety over the last few years. The ONC has funded numerous reports and projects for this very reason and holds meetings with the Agency for Healthcare Research and Quality (AHRQ) to coordinate health IT and patient safety. AHRQ has recently awarded $4 million in new research grants to improve the safety of health IT. More information can be found at healthit.ahrq.gov.

Focusing on processes to ensure better use of health IT, from the true adoption of applications to how they are being used in real time and what issues arise, will make us all safer and provide a better patient experience. The right intentions have been there for 50 years. We’ve had successes and growth, and are getting better at defining the needs of patients, providers, and organizations to reach the ultimate goal of safety.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

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